Despite low reimbursement from Medicaid and other payers for disposables, the company tries to do right by its patients, says Greenstein.

“It becomes financially challenging—we try to do our best within the confines of their insurance,” he said. “Most of these are very low value, low markup, but there’s volume.”

To stay viable, providers need to constantly look for new avenues of revenue. Mercy Home Care, for example, has an online retail presence, including on Amazon.

“I think Amazon is going to take over the world,” said Greenstein. “Before this, I worked for another DME. I’ve seen a lot of changes over the years—some for the best, some for the worst. The traditional model no longer works.”

Mercy Home Care also does a lot of business providing DME to hospice patients, which he likens to the “Dominos Pizza of DME” due to the urgent nature of getting equipment to those patients.

“I like hospice because we are truly helping a person in the last stages of their life,” said Greenstein. “(Helping people) is why I got into this business, having been an EMT earlier in life.”

Despite the challenges of today’s HME environment, Greenstein is content where he is. He’s had offers from national providers but prefers to remain a “free thinker.”

“If a patient needs a certain product that may not be covered, we always want to do the right thing,” he said. “It’s just becoming very difficult to do so without losing money.”